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Addiction and Opiates

Addiction and Opiates

Addiction and Opiates CHAPTER 1 METHOD AND PROBLEM made by Dr. Albrecht Erlenmeyer in an article concerned mainly with the physiological effects of morphine. Speaking of withdrawal distress, Erlenmeyer said, "In such moments the craving for morphine is born and rapidly becomes insatiable, because the patient has learned during the period of habituation, when abstinence symptoms always set in after the effect of the last morphine dose has passed off, that those terrible symptoms are banished as if by magic by a sufficiently large dose of morphine ."(2) In the light of this statement, the second hypothesis of the investigation was that persons become addicts when they recognize or perceive the significance of withdrawal distress which they are experiencing, and that if they do not recognize withdrawal distress they do not become addicts regardless of other considerations. This formulation proved to be much more significant and useful than the first, but like the first it did not stand the test of evidence and had to be revised when cases were found in which individuals who bad experienced and understood withdrawal distress, though not in its severest form, did not use the drug to alleviate the distress and never became addicts. The final revision of the hypothesis involved a shift in emphasis from the individual's recognition of withdrawal distress to his use of the drug to alleviate the distress after this insight has occurred. This hypothesis was found to be superior to the others. It had the advantage of attributing the origin of addiction, not to a single event, but to a series of events, thus implying that addiction is established in a learning process extending over a period of time. If one thinks of the central problem of addiction as being that of isolating and describing the nature of the experience from which the fatal craving or "book" is derived, the hypothesis stated above suggests that the critical experience in the fixation process is not the positive euphoria produced by the drug but rather the relief of the pain that invariably appears when a physically dependent person stops using the drug. This experience becomes critical, however, only when an additional indispensable element in the situation is taken into account, namely, a cognitive one. The individual not only must experience relief of withdrawal distress but must understand or conceptualize this experience in a particular way. He must realize that his distress is produced by the interruption of prior regular use of the drug. It is evident that when a person becomes addicted to heroin or morphine the entire pattern of his social behavior is commonly altered to a pervasive degree and that his orientation toward the drug is radically altered. These drastic changes in behavior and attitude are not of the kind that could reasonably be expected to occur in an instant. They are learned, according to the theory, in a gradual but rather rapid way as the withdrawal distress recurs and must repeatedly be banished by further use of the drug. Even though the beginner may like the effects of morphine or heroin, the prospects of becoming an addict are traumatic if they are actually fully understood. In this sense, the addict does not ordinarily become such voluntarily but is rather trapped "against his will" by the book of withdrawal. If one disregards the cognitive aspect, one can say of this hypothesis that it is a theory emphasizing negative rather than positive reinforcement as the basis of addiction. In psychological writings the term 11 negative reinforcement" is used to refer to a situation in which a given action is rewarded by the elimination of something unpleasant-an adverse stimulus. Thus, if a child is locked in his room until be masters his school assignment, his reward for doing it will be that he will be freed from confinement. This is negative reinforcement. If, on the other band, the child is promised a much desired trip to the zoo when be completes his homework, this is called positive reinforcement. It will be pointed out in a later chapter that psychologists have explored the theory advanced here, minus the cognitive feature, in ingenious experimental investigations of the effects of opiates on lower animals. Some of this work strongly suggests that insofar as lower animals are capable of matching the behavior of human subjects in becoming attached to drugs, their attachment also depends upon the negative reinforcement obtained from the relief of withdrawal rather than on positive reinforcement stemming from pleasurable effects of the drugs. Investigations of this type which necessarily ignore the differences between human beings and animals occasioned by the former's immense cognitive superiority leave open the question of the extent to which the responses of lower animals to opiates can be made to parallel those of human subjects. In a subsequent chapter attention will be given to the matter of determining whether it is justifiable or meaningful to assert, as some investigators do, that addiction can be induced in rats, monkeys, and other animals. The hypothesis of this study was tested under the following assumptions: ( 1) the verification of a theory consists not in piling up selected instances which confirm it but in looking for evidence which contradicts clear logical implications which may be deduced from it; (2) a valid theory of addiction must account for the basic or essential aspects of file:///I|/drugtext/local/library/books/adopiates/chapter1.htm[24-8-2010 14:23:31]

Addiction and Opiates CHAPTER 1 METHOD AND PROBLEM addiction by indicating that they form a system or pattern which is logically implied or predicted by the theory. All of the evidence obtained from the literature and from conversations with all subjects was considered from this point of view. None of it seems to me to contradict the theory. On the contrary, the theory seems to make sense of a number of aspects of addiction which have usually been regarded as paradoxical or puzzling from other points of view. It also suggests a simple unitary explanation of a central theoretical problem, that of accounting for the fact that physical dependence on opiates is sometimes followed by addiction and sometimes is not. The fact that the hypothesis of the study was revised a number of times in the course of the investigation suggests that further evidence or the extension of the theory to other forms of addiction may necessitate further reformulations. This is a probability rather than a mere possibility and seems to me to constitute an advantage rather than a weakness. It is characteristic of all genuine scientific systems that they evolve as they are confronted with new evidence that does not fit the old theories. The prime virtue of a general theory is that it stimulates the search for negative evidence and challenges its critics to construct a better one. It may be asked whether the search for negative cases was properly conducted and if the observer has not neglected evidence of a contradictory character. To this, of course, there is no final answer. It is probable that somewhere in the course of any study unconscious distortion takes place. Concerning the central hypothesis and the direct lines of evidence, however, certain procedures were followed which may be said to exclude bias. For example, when the theory had been stated in an approximation of its final form it occurred to me that it could be tested in cases where an individual bad bad two separate experiences with morphine or opiates, each of which was sufficiently prolonged to produce withdrawal distress but with addiction following only the second episode. Case 3 in Chapter 4 is an example. It was concluded that if the theory was valid, the person would report that he bad failed to realize the nature of the withdrawal in that experience from which he had escaped without becoming addicted. Thereupon a thorough search was made for cases in which an individual had undergone such an experience with the drug prior to becoming an addict. All cases of this kind which could be found, or of which any record could be located, were taken into account. Any of these cases might have contradicted the final hypothesis, but none did so. The inference or prediction which had been drawn on the basis of the theory was thus fully borne out. This procedure was followed throughout the study wherever possible and, as will be seen, is implicit in the form in which the theory is stated. As previously mentioned, I scrupulously refrained from informing the addict of any theories which I held or of the exact reasons for my inquiries. Thus when an addict was asked about his experience during gradual withdrawal cures he was not told that an attempt was being made to check the implications of the theory. It was inferred that if addicts feel approximately normal between shots as they maintain they do' it should be possible to deceive them as to whether they are really getting the drug. During the discussion of such gradual withdrawal cures, the information was often volunteered by the addict that be himself bad been deceived at some time into believing that he was getting the drug when he actually was not, or vice versa. This information was usually introduced with the remark that he did not expect to be believed, whereupon be would proceed to give the facts which corroborated the theory and which had been anticipated. In none of these cases, however, did the addict know when be gave the information that it had any significance for a theory of addiction. It has often been said that testimony of addicts is virtually worthless because of the secrecy surrounding addiction and the tendency of drug users to distort and falsify. I have found that this view is incorrect. The addict lies and distorts not because be has any indiscriminate urge to do so but in order to obtain certain definite and practical results. If it is clear to him that be has nothing to gain by lying and nothing to lose by telling the truth, he is as straightforward and honest as anyone else. Of course, he will rationalize and offer excuses, but in this sense be is no different from nonaddicts. It is true that there are certain areas in which the addict has very strong inhibitions against giving the unvarnished truth, but these inhibitions apply entirely to information which was not relevant to the central problem of the study. A drug user is particularly cautious about information concerning the sources of his supply, and if he is engaged in theft or other illegal activity he will be very reluctant to describe this activity. Since matters of this kind had no bearing on the central problem being investigated no special effort was made to obtain these data, although practically all the addicts who were interviewed eventually volunteered such information. The drug user has no special tendency to falsify concerning the nature of the drug habit. The fact that contact was maintained with some of the cases over a period of file:///I|/drugtext/local/library/books/adopiates/chapter1.htm[24-8-2010 14:23:31]

Opioid Addiction
PRESCRIPTION ADDICTION